What Causes Sleepwalking - Featured

What Causes Sleepwalking and How Can You Prevent It?

by Dr. Lina Velikova, MD

What causes sleepwalking, also known as somnambulism? Sleepwalking is a relatively common behavioral disorder. Specifically, the sleep disorder is characterized by walking or performing other complex actions during the deep phase of sleep. While sleepwalking’s causes are somewhat known, many elements of the condition itself remain a medical mystery.

Why Do People Walk in Their Sleep?

Most often, sleepwalking first manifests in childhood, as the main predisposing factor for this condition is sleep deprivation. Since sleepwalking occurs during deep sleep, it can be a challenge to wake the affected person up, and the latter often has no memory of what happened during their somnambulism episode. 

In most cases, sleepwalking involves a series of complex actions, which is why sleepwalking injuries aren’t unheard of. In fact, sleepwalking activities can range from just sitting up in bed and looking around or walking about the room or home to going out and even driving a long distance. Obviously, more complex activities could be dangerous. The common misconception for this condition is that the sleeping person shouldn’t be woken up. However, considering the risks, it’s better to wake them up before they do something dangerous.

The latest research on sleepwalking has revealed that when people sleep, they aren’t necessarily wholly asleep at all. It was shown that only part of the brain is “sleeping,” and the other parts are “awake.” The sleeping brain most commonly refers to areas in the cortex responsible for self-control, reasoning, and memory. The always awake zones are located within the brain’s inner layers. This division explains how people who sleep are capable of dancing, talking, driving, or having sex. 

Knowing what part of the brain controls sleep walking, we have to emphasize that all actions during sleepwalking are already learned skills. For example, it’s impossible to play Chopin if you’ve never done it before. 

However, it’s quite possible for somnambulism patients to be subjected to intolerable conditions without feeling pain or discomfort. A sleepwalking patient can go barefoot outside at -20º Celsius without realizing their feet are freezing or swim without understanding that they’re wet. The strange stories about sleepwalking include some patients even going so far as killing another person. It’s stories like this that demonstrate why this condition shouldn’t be overlooked.

If sleepwalking is just a unique episode, then it’s not a cause for concern. If it happens more often, however, it’s necessary to pay attention to it and seek medical advice.

Can Sleepwalking Be Dangerous?

It’s been assumed that from a medical point of view, walking during sleep isn’t a dangerous condition, as long as the risk of any side effects is eliminated.

What Causes Sleepwalking - Dangers

The incidence of somnambulism in the general population ranges from 1% to 15%. It occurs most often in childhood, especially in the age group of 3–7 years of age, during which it’s considered an ordinary event. Additional statistics show that about 15% of children under the age of 12 experience sleepwalking without any negative consequences. Sleepwalking death statistics, in fact, show that the mortality rate is too low to be estimated. 

A particularly risky group for somnambulism is children with sleep apnea, according to the statistics. A higher rate of the disorder was also registered in children suffering from bedwetting. This disorder has also been observed to be moderately hereditary, i.e. the condition can be transmitted to one’s offspring.

Regarding adults, it was estimated that about 3% of them are sleepwalkers.

What Causes Sleepwalking in the Brain?

The exact cause of somnambulism isn’t well understood. However, according to studies, children are the most vulnerable because their brains are still developing.

In brief, sleepwalking occurs when something causes the brain to leave its state of deep sleep and enter into an intermediate status—somewhere between sleeping and awake. Since dreams arise only during the REM (rapid eye movement) sleep phase, sleepwalkers shouldn’t experience them during an episode.

An episode of sleepwalking for the first time can last anywhere between a few minutes and an hour. The episode frequency varies from person to person. During one, a person’s attention and reactions to external stimuli are diminished. The sleepwalker is asleep, but their body is active, allowing them to perform complex actions such as eating, walking, and talking.

Some people only experience sporadic episodes of sleepwalking, while others suffer from this condition several times a night. The somnambulist can seem pretty clumsy, and there are several dangers of sleepwalking: a sleepwalker could stumble on furniture, try to walk through the mirror, or fall through the window or down the stairs. Nevertheless, most episodes don’t result in an injury.

People who suffer from this type of sleep disorder and have been woken up are usually unfocused and confused. Typically, the affected people return to bed or wake up elsewhere in the house.

What Causes Sleepwalking and Talking?

What Causes Sleepwalking - Causes

The most significant controversy in sleepwalking—including talking in one’s sleep—is the question of the disorder’s real cause. Currently, studies have provided some data elucidating some of the well-established factors that indicate a risk or predisposition to somnambulism.

Although it’s more prevalent in childhood, its appearance or persistence in adulthood is also common. Usually, the onset of somnambulism isn’t associated with a severe psychological or psychiatric problem.

There are various sleepwalking causes. Most likely, the leading cause is a genetic predisposition. If there’s a family member who sleepwalks, then the chance of the child inheriting this problem is ten times higher. It’s also been established that identical twins are more prone to somnambulism.

Frequent Triggers

  • Sleep disorders: sleep deprivation, inadequate and irregular sleep, obstructive sleep apnea, restless legs syndrome
  • Alcohol use and abuse
  • Febrile states
  • Lack of magnesium in the body
  • Menstrual cycles (including premenstrual syndrome) or pregnancy
  • Medications that cause sleepwalking, including sedatives and sleeping pills: phenothiazines, chloral hydrate, zolpidem, and lithium
  • Environmental stimuli
  • A full bladder
  • Vibrant dreams and nightmares
  • Emotional or situational stress
  • Fear of separation in children
  • Some medical conditions: stroke, head injuries, seizures, migraine, hyperthyroidism, or depression

All of these can cause sleepwalking. Interestingly, there are some gender-based factors—pregnancy and menstrual cycles can increase the likelihood of falling into a state of somnambulism. 

Sleepwalking in children is often associated with a full bladder and nighttime incontinence. Studies have shown that some sedative and hypnotic drugs can alter sleep mechanisms and sleep phases—making it a challenge for someone suffering from urinary urgency to wake, for example. In these cases, if someone needs to go to the bathroom while in a half-asleep state, the sleepwalker may not find the bathroom at all.

There have been documented sleepwalking stories associated with changing the bed, sleeping in a new and unknown place, leaving a lamp on in the bedroom or while traveling. All of the enumerated factors indicate the occurrence of somnambulism.

Excessive stress and its related anxiety are the most common causes of sleepwalking at any age. Luckily, this is also the most easily overcome risk factor. So if you’re concerned about what causes sleepwalking in adults and children, consider trying out one of the many stress-relieving techniques available to you.

In line with this, the problems with sleepwalking can be gradually resolved if the underlying causes are eliminated. First, improving your sleep pattern usually helps reduce the number of episodes quickly. Check out the space you sleep in. If your mattress is old and deformed, replace it with a new quality mattress or a top mattress to create a safe and cozy sleeping environment.

What Are the Most Common Sleepwalking Symptoms?

What Causes Sleepwalking - Symptoms

Sleepwalking occurs most often during the deep sleep stage, but it can also happen in the more superficial phase of NREM sleep. This usually happens a few hours after falling asleep, when the sleeping person may be in a lighter sleep mode.

In addition to walking during sleep, these are the other accompanying symptoms:

  • Speaking
  • Screaming—primarily when it occurs in combination with a nightmare
  • Blackout sleep walking
  • Staying seated on the bed with a blank expression
  • Others having difficulty waking the sleepwalker during the event
  • Violent behavior toward the person trying to awaken the person sleepwalking
  • Urinating in inappropriate places—for example, in the closet
  • Rearranging the furniture
  • Leaving the house, including through the window
  • Driving
  • Participating in a sexual act 

This behavior ranges from simply odd to life-threatening—for example, driving or shooting a weapon. But can you remember sleepwalking? Since the person is in an altered state of consciousness and their judgment isn’t its best, when someone tells them what happened the next day, the sleepwalker usually can’t believe what they did and won’t remember anything. However, older people are more likely to remember moments or vague impressions of the event.

How Is Sleepwalking Diagnosed?

Anyone who has had more than one episode of somnambulism should visit a doctor for a thorough review. The doctor will examine the patient’s medical history and the current state of their health. It’s a good idea to keep a diary describing details of the events—when it happened, how long it lasted, what actions and movements you made, and whether there were distinct factors that triggered the episode.

Blood tests may also be performed to rule out a possible hormonal imbalance, since some case studies support this connection.

To find out what causes sleepwalking and sleep talking in the elderly, polysomnography may be assigned to see if the patient suffers from any sleep disorder. Again, obstructive sleep apnea is a common cause. Using electroencephalography (EEG), a medical professional can determine whether a patient’s sleepwalking is brought on by a type of seizure. In 47% of the patients suffering from parasomnias, an EEG test detected an abnormality.

How to Stop Sleepwalking

There is no specific treatment for somnambulism. In most cases, maintaining proper sleep hygiene and having good wake-up habits will be enough to minimize your sleepwalking episodes. However, it’s essential to learn if you have any underlying diseases. And stress, the use of certain substances and medications, and accumulated fatigue may also cause the condition. To keep the problem from worsening, specialists usually recommend a lot of rest—instead of resting after sleep, a sleepwalking patient sometimes feels overwhelmed.

We already know that what causes sleepwalking in kids isn’t necessarily the same as it is with adults. In most cases, childhood somnambulism is a self-limiting condition, and the events gradually become less frequent or completely disappear as the child grows up. This happens because the deep phase of sleep—when sleepwalking most commonly occurs—gradually shortens as children get older.

No matter the cause, it’s necessary to provide a secure environment around the child’s bed to avoid possible injuries. Windows and doors should be closed so they can’t go too far during an episode, and any dangerous items should be removed from the room.

Sleepwalking Treatment and Prevention

What Causes Sleepwalking - Treatment

From what’s been said so far, the most effective way to manage sleepwalking is to consult a specialist. Only a doctor can recommend an adequate and long-lasting solution to the problem.

Therapy for adult sleepwalking can include the use of sedative drugs or antidepressants. There are drug therapies that can be used to control the symptoms: lorazepam, clonazepam, amitriptyline, trazodone, etc.

An effective sleepwalking treatment also includes managing other sleep disorders, such as obstructive sleep apnea, restless legs syndrome, or other medical conditions like gastroesophageal reflux, depression, and anxiety. Recovering from these conditions may help reduce sleepwalking episodes.

It’s also a good idea to observe a specific bedtime schedule while perhaps applying certain relaxation techniques before going to bed.

Sleepwalking and Hurting Yourself

Although quality of sleep usually isn’t impaired when sporadic sleepwalking episodes occur, when they’re repeated, they can cause considerable anxiety for the sleepwalkers and their family, as well as severe injuries.

Not all episodes of somnambulism can be prevented. Nevertheless, it’s possible to reduce their frequency by controlling the factors that are known to induce them. 

So how do you stop sleepwalking? Consulting a doctor is key, but there are also some steps worth taking to protect the sleepwalker from endangerment:

  • Lock the windows and doors that lead outwards.
  • Place the mattress directly on the floor or use a sleeping bag instead of standard sheets.
  • Remove all dangerous objects including mirrors and tripping dangers from the sleeping space.
  • Hide and lock any weapons away.
  • Place pads/bedding next to the furniture and on the floor next to the bed.
  • When the house has several floors, the sleepwalker’s bedroom should be on the first one.
  • Install an alarm on the bedroom door.
  • Place a barrier at the top of the staircase.

FAQ

Are you supposed to wake up a sleepwalker?

If you find your loved ones sleepwalking, try not to wake them up. This may startle or confuse them. Instead, guide them carefully back to bed. If the sleepwalker threatens themselves or other people, then it becomes necessary to wake them. Contrary to belief, it won’t hurt them—they’ll just be confused. Typically, the sleepwalker won’t remember anything of what happened come morning.

How do I stop my child from sleepwalking?

You can help your child by ensuring they maintain a regular sleep regimen and making sure they get enough sleep. Also, try to keep a soothing environment in the bedroom—a comfortable bed, curtains for dimming the room, and a lower temperature. Another important factor is helping them eliminate or control any stress or anxiety.

Does sleepwalking go away?

When episodes occur once or twice a month, treatment isn’t necessary. You have to remember that sleepwalking is seldom a dangerous condition and will ultimately go away one day. But safety precautions will need to be implemented, as somnambulism can lead to accidents or self-harm if a patient falls or tries to leave the house.

Does sleepwalking run in families?

A clear genetic connection is the most definite predisposing factor for sleepwalking. However, there are several mitigating measures that focus on sleepwalking’s other causes. If these are managed well, then even those with a hereditary predisposition for sleepwalking should see improvement.

Conclusion

Sleepwalking is a medical condition that deserves our attention, mostly because of its impact on quality of life and the risk of possible trauma. Being aware of what causes sleepwalking can help you avoid the condition’s unpleasant consequences and complications—and it might help you catch a deeper underlying problem early.

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